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General NPI Number Information
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NPI Number | 1720706450
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Entity Type | Organization
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Legal Business Name | WELLCARE, INC
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Dates
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Enumeration Date | 08/18/2022
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 2105 ACADEMY CIR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-1663
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Country | US
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Telephone | 719-598-5555
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Fax | 719-388-2030
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Provider Business Mailing Address
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Address Line | 5446 N ACADEMY BLVD STE 105
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-3668
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Country | US
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Telephone | 719-598-5555
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Fax | 719-388-2030
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Authorized Official
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Title or Position | OWNER
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Name | TIM DAN CAMPBELL
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Credential |
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Telephone | 719-598-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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